Provider Demographics
NPI:1659980324
Name:CROUSE, CASEY LYNN
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:CROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 LEGATE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3354
Mailing Address - Country:US
Mailing Address - Phone:540-815-0988
Mailing Address - Fax:
Practice Address - Street 1:901 BROAD ST STE 101A
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1708
Practice Address - Country:US
Practice Address - Phone:304-872-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant